The GMC has called on GPs to invest in ‘smarter’ computer systems and open their records for pharmacists to review their prescribing, after a study found mistakes or omissions in one in 20 prescriptions.
Data from the one-year PRACTICE study – first revealed by Pulse earlier this year, and officially released today – showed that 4.9% of GP prescriptions had an error.
The study has already prompted the RCGP to review its training curriculum to include a requirement for GP trainees to demonstrate competence in prescribing and medicines management.
The study examined nearly 1,800 patient records. There were 247 prescribing errors identified, the most common of which were ‘incomplete information on the prescription’ (31%), dose errors (17%) or timing errors (11%). There were also 55 monitoring errors, the most common of which was a ‘failure to request monitoring’, found in 70% of cases.
Fewer than 4% of the errors were judged to be severe, although errors were more common in older patients and in patients receiving five or more drugs.
PRACTICE study leader Professor Anthony Avery said many of the errors came from prescribing being ‘squeezed in’ at the end of a consultation.
He said: ‘You can end up relatively quickly going through the prescription items, when we all know that – particularly for elderly patients – you need a careful review of medications.’
The GMC said overall the results showed GPs were prescribing to a ‘good standard’ and mistakes were mainly due to ‘human factors.’
GMC chair Professor Peter Rubin, said: ‘One of the problems is that [GP computer systems] flag up every conceivable side-effect and drug interaction , but some of these are quite trivial and doctors come to ignore them. Using smart software is a key issue.’
The PINCER trial published in February showed pharmacist reviews in GP practices cut prescribing errors by nearly a third. Professor Rubin also said he would be working with RCGP and the health departments to ensure a system piloted in GP practices where pharmacists review patients and feedback on prescribing is rolled out further.
He said: ‘A lot of what needs to be done here is not complicated or expensive. It is to do with reviewing your processes, ensuring that those in place reduce human error to the absolute minimum.’
Responding to the release of the report, RCGP chair Dr Clare Gerada said the College was in the process of updating their curriculum to reflect the study findings.
‘The GP training curriculum, introduced by the RCGP in 2007, is also in the final phase of a three year revision which will shortly be submitted to the GMC,’ she said. ‘In the current version of the curriculum, patient safety is the main objective of prescribing. In the revised version doctors will be required to demonstrate their competence in both prescribing and medicines management.’